DESCRIPTION (provided by applicant): Asthma is the most common pediatric chronic disease, affecting more than 10% of American children (>7 million children <18 years)1 and disproportionately impacting urban, minority, and disadvantaged children.2 Despite the evidence-based guidelines for standardized care from the NIH,3 overall morbidity among youth with asthma, whether measured by attack rates, emergency department (ED) visits, or hospitalizations, has not significantly decreased in the last decade.4 Striking disparities persist
among youth with asthma, as socio- economically disadvantaged, urban, and minority children throughout the United States incur a disproportionate share of asthma-related morbidity.2,5 The overall ED visit rate for asthma, for example, among non-Hispanic African Americans (AAs) aged 0-17 years is 4.1 times greater than that among non-Hispanic whites, while the ED visit rate among Hispanics in the same age group is 1.8 times greater than non-Hispanic whites. Similarly, the asthma death rate among non-Hispanic AAs aged 0-17 years is 7.3 times greater than that among non-Hispanic whites, while the death rate among Hispanics in the same age group is 1.2 times greater than non-Hispanic whites.5 In a recent study to prioritize comparative effectiveness research in hospital pediatrics, asthma ranked as the #1 leading non-surgical diagnose for pediatric hospital admission, totaling costs of $570 million annually.6 Of striking importance for the health care system is that asthma is also in the top diagnoses for all-cause readmissions, with 80% of these asthma readmissions deemed potentially preventable readmissions.7 In this career training award, with a strong mentorship team, I propose a highly patient-centered approach to identifying and improving optimal outcomes for patients and families transitioning home after inpatient admissions for asthma exacerbations. Using the care coordination framework proposed by the Agency of Healthcare Research and Quality (AHRQ) in June 2014,8 my mentors and I will utilize principles of patient-centered outcomes research (PCOR) and comparative effectiveness research (CER) to design and pilot a program of community health worker (CHW)-facilitated transition-to-home focusing on the changeover of care from inpatient to outpatient for patients hospitalized with asthma exacerbation. This project is highly significant (addressing a vulnerable transition for patients admitted with a common and costly pediatric chronic illness with high rate of preventable readmissions) and highly innovative (using a qualitative approach to identify stakeholders' perspectives to refine AHRQ's care coordination framework to improve the transition from hospital to home by utilizing CHW and pilot testing feasibility and acceptability, and patient-centered outcomes). Our overall aim is to develop and evaluate a patient-centered transition-to-home plan leveraging CHWs to target high risk pediatric patients requiring hospital admission for asthma exacerbations. Our hypothesis is that CHWs will improve patient-centered outcomes during the transition from inpatient to outpatient care.
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